Fractures at any adult age, including early adulthood, may be linked to an elevated risk of future fractures, according to a recent study.
In the study, published in JAMA Network Open, investigators evaluated the relationship between the age at first fracture and subsequent fracture risk in older adults. The findings indicated that fractures occurring at any age during adulthood are associated with an elevated risk of future fractures, highlighting evidence that thresholds excluding early adulthood fractures may underestimate risks in fracture risk assessment tools.
The population-based cohort study included 88,696 participants from the Manitoba Bone Mineral Density Registry, with a mean (standard deviation [SD]) age of 64.6 (11.0) years and a mean (SD) follow-up period of 9.0 (5.5) years. Among the participants, 21,105 (23.8%) had a history of fracture, with a mean (SD) age at first fracture of 57.7 (13.6) years. Incident fractures were identified in 13,239 participants (14.6%), including osteoporotic fractures in 14.0%, major osteoporotic fractures in 10.6%, and hip fractures in 3.5%.
Sex- and age-adjusted hazard ratios (HR) for future fractures ranged from 1.55 (95% confidence interval [CI] = 1.28–1.88) to 4.07 (95% CI = 2.99–5.52), depending on the fracture type and age at first fracture. Fully adjusted HRs remained elevated, ranging from 1.51 (95% CI = 1.42–1.60) to 2.12 (95% CI = 1.67–2.71). The participants with first fractures in early adulthood (20 to 29 years) exhibited the highest relative risk for future fractures, though no significant trend was observed across age groups.
The findings supported the consideration of fractures occurring at younger ages in clinical risk assessments. Current fracture risk calculators, such as the Garvan and American Bone Health tools, may not fully account for fractures occurring before ages 40 to 50 years. By contrast, FRAX considers all adult fractures, consistent with the study’s findings.
The findings highlighted the importance of considering all adult-age fractures in risk assessment tools.
Full disclosures can be found in the published study.